Storage, Transportation and Final Disposal

1. INTRODUCTION

4.4 Storage, Transportation and Final Disposal

In government hospitals on asking about the storage of this waste researcher came to know that after collection of this waste it is openly dumped around hospital premises. After 3-4 days when this area become filled TMA van collect and transported this waste for final disposal at Sheikh Sukha.

Whereas in private hospitals respondents told to the researcher that after collection of waste from each ward, For temporary storage we have separate container and trolley outside the hospital building, sweepers throw-off all of the hospital waste in "Blue color" container and "Yellow color TMA trolley" (Shown in Appendix 3). Respondents also told that , every early morning TMA vans collect all of these wastes from these containers from the private hospitals, then get mixed with municipal waste and transported for finally dispose at a biggest waste dumping site of Gujrat, which is known as Sheikh Sukha. Private hospital's administration told to the researcher that TMA collect this waste on monthly charges around 7000-10,000 Rupees (approx.; 70 to 100US$).

In the case of government hospitals, after the collection of waste from each ward it was openly dumped around hospital premises making identical garbage heaps. To collect the recyclable products from these garbage heaps there was an open access for scavengers. TMA is a government organization and therefore, due to lack of strict monitoring by the hospital administration usually, after 3-4 days TMA vans collect this waste and transport it to the final disposal site. During summer and rainy seasons, these open garbage heaps produce mosquitoes and house flies. On other hands private hospitals, due to strict monitoring by hospital administration, waste primarily stored in containers and trolleys are regularly transported by TMA to the final disposal site. To prevent the access of scavengers, waste storage area was completely locked. Moreover, to prevent ill smelling production, some chemical sprays were used by the sanitation staff. Due to regular transportation of waste, hospital area was found completely clean and tidy. These differences illustrated that in private hospitals the waste management practices regarding storage, transportation and disposal were much better than in government hospitals.

22 4.5 Burning of Hospital waste:

In government hospitals researcher also observed that behind the hospital buildings, big holes were found. On asking from sweepers about the reality of these holes, they replied that, on the instructions of the hospital's administration, they filled these holes with infectious and hazardous waste which they got rid of by burning.

On asking the reason of burning this hazardous waste, respondent replied that only in one Government hospital of city Gujrat, there is an incineration plant. This plant was installed on 16th May 2013 by the contribution of WHO to prevent blood borne infectious diseases such as viral Hepatitis and HIV/AIDS but unfortunately, it has been non-functional since July 2013 because of non-availability of a technical person, lack of fund and maintenance charges. Therefore, for hospital waste management there is no other option than burning to get rid of this infectious and hazardous waste.

In the case of private hospitals, any information regarding waste burning inside or outside of the hospitals was not collected. On asking, hospital staff mentioned that burning of waste is a serious crime because it can cause many health hazards. Therefore the hospital management can’t allow burning of infectious and hazardous waste. However, there is no incineration plant in private hospitals.

4.6 Recycling of waste

The researcher analyzed the existing status of hospital's recyclable waste on the basis of interviews and informal discussion with hospital staff and on visual examination during these government hospital visits. Researcher came to know that empty glass/plastic bottles, containers and tins were mainly re-used by doctor's assistants and compounders without sterilizing them.

However, recyclable products such as glucose bags, urine bags, tins, used syringes, paper, card-board, plastic bottles and infusion tubes were collected and sorted by the sweepers and scavengers within hospitals premises and outside the hospital boundaries respectively. Sweepers and scavengers perform these duties without realizing the serious health issues such as Hepatitis B, C, HIV/AIDS and many other allergic issues which can be caused by handling and due to contact with these infectious/toxic wastes. On asking about the reason for the collected and

sorted recyclable waste, respondents mostly replied that these recyclable products can be easily sold on for good prices at scrape yards.

For the private hospitals, the recycling status is also almost similar as that in the government hospitals. The recyclable products which are produced in private hospitals are collected and sorted by sweepers. On asking about the collection and treatment of recyclable waste, respondents replied that during collection and cleaning of wards, sweepers normally sorted all of the recyclable products and store them in separate containers. When the container becomes full, they sold all of these products at scrape-yards.

4.7 Comparative Analysis of HWM Practices Between Government and Private Hospitals:

A comparative analysis of HWM practices between government and private hospitals of Gujrat city based on primary data and visual examination is discussed in this section.

Waste which is produced in the government and private hospitals, usually collected by sweepers and waste collectors but unfortunately due to absence of proper dumping and storage area in government hospitals, waste is openly dumped into the open air which makes identical garbage heaps around hospital premises. TMA transported this waste to the final disposal sites after 3-4 days. However, in private hospitals due to strict management and regular monitoring by hospital administration, waste is properly stored for maximum 24 hours in the specific storage area. To keep this area protected from the access of scavengers, it is properly locked. This waste is regularly transported to the final waste disposal site by TMA. For infectious and hazardous waste treatment, incineration facility is available only in the government hospital 1,but this incineration plant has been un-operational since July 2013 due to lack of budget, high maintenance and operational charges, as well as lack of technical information etc. Therefore, to get rid of this waste, open burning is the final option for hospital administration. Although waste burning is prohibited due to its harmful environmental impacts, the practice is very common, especially in government hospitals. Due to high penalties for this criminal offence, private hospitals do not burn their waste. In private hospitals, infectious and hazardous waste is separately collected, stored and disposed of finally by TMA.

In government hospitals, needle cutting techniques are normally not applied due to the lack of needle cutters and unavailability of safety boxes. During personal visit to these hospitals,

researcher noticed many intact needles on garbage heaps which were collected by scavengers as a recyclable product. Pictures of un-cut needles are given in Appendix 3. However, in private hospitals, due to the superintendent regularly monitoring and the refresher of the training courses based on hospital waste management rules 2005, proper destruction of needles and other infected sharps is done by hospital staff including doctors, nurses and paramedics. For proper cutting of used needles, hospital administration provided at-least one needle cutter and safety box per ward.

Initially, waste produced in hospital wards is collected in dustbins but researcher found that in government hospitals, the number of dustbins was insufficient, patients and their visitors were throwing their waste under their beds or around the hospital premises. When asked from the administration, they replied that due to lack of budget they could not buy a sufficient amount of baskets. On the other hand, in private hospitals, a sufficient number of dustbins are available. For proper collection of waste, hospital administration provided at least one basket to each bed wrapped with biodegradable plastics bags that make its bottom clean and prevent from ill-smelling in the ward. Pictures of dustbins with biodegradable plastic are given in Appendix 3.

Due to lack of knowledge about color coding scheme, no segregation practice for paper, plastic, glass and other general waste was implemented in either the private or the government hospitals of Gujrat, City. Researcher found that in both government hospitals of Gujrat City, hospital administration do not provide protective measures including gloves, face masks, and safety shoes for the sanitation staff and waste handlers to prevent them from getting diseases especially during infectious waste handling. However, in the case of private hospitals, due to a proper waste management system and awareness regarding health impacts, hospital administration does not only provide protective measures but they even strictly apply these practices among their waste workers.

Although waste management regulations and the maintaining of proper records is on the responsibility of hospital administration (Rasheed et al. 2005), there is no documentation maintained due to lack of internal and external monitoring in either of the government hospitals of Gujrat city, whereas in both private hospitals there was complete documented compliance due to strict management system.

As mentioned before there are only two government hospitals in the city of Gujrat where there are around 50 private hospitals that have been established for commercial purposes. Therefore, there is tough competition among private hospitals to attract patients. To improve their business

private hospitals always try to provide better facilities for their patients by keeping the administration strict. The hospital administration strictly follow and implement the hospital waste management rules. Moreover, due to strict penalties enforced by government health departments, the administration of the private hospitals always try to keep the hospital area clean and keep proper documentation regarding waste management. Whereas in the case of government hospitals there is no proper waste management system due to the absence of a strict internal and external monitoring. Rules enforcement agencies and hospital administration get favors from each other so therefore, the implementation level of waste management rules is comparatively lower than in the case of private hospitals. Moreover, political interference in government hospitals is another hindrance to implement HWM rules. The medical and administrative staff at the government hospitals get access political authorities in case of any penalties imposed by the health department.

5.0 IMPACTS OF HOSPITAL WASTE ON THE HEALTH OF PEOPLE

LIVING AROUND WASTE DUMPING SITE;SHEIKH SUKHA:

This chapter is based on the information collected through question guides from local people living around biggest waste dumping site of Gujrat city which is known as Sheikh Sukha.

Researcher personally visited this site and collected the information through questionnaires regarding health issues caused by hospital waste. To get deeper knowledge about the Sheikh Sukha waste dumping site, researcher asked questions from local people living there since childhood or longer than 5years. The collected information regarding health impacts on the people of Sheikh Sukha caused by the open waste dumping is given below;

5.1 Background Information about Sheikh Sukha Waste Dumping Site:

Questions were asked from the village people as well as TMA staff about the reason the Sheikh Sukha land became a dumping site. The respondents from TMA told that initially, this land was purchased to install a fertilizer industry and there was no such proposal about open waste dumping. TMA representatives convinced the local people by saying that TMA would collect the solid waste from the city and this waste would be processed and used to make fertilizers in this industry. Moreover, this industry would bring employment opportunities for the local people but thereafter, no fertilizer industry was established and the site remained as open waste dumping

area. The people complained but TMA regularly started to dump waste openly without any collective decisions between TMA and local community. However, inhabitants formerly started protest and registered complaints against this illegal act but no action so far has been taken against TMA. TMA officials told that there is no other option and nor the TMA has any budget for shifting the waste to other place. The respondents in the village complained that the local political leaders are not taking interest in the solution of the issue.

5.2 Burning of Waste and Its Associated Diseases:

Akter (2000) reported that open waste burning at low temperature can release many toxic chemicals into the atmosphere, which may result in eye, skin, lung, heart and throat diseases.

During this field survey, on asking about the burning of waste, people informed the researcher that this burning is mainly done by TMA workers to minimize the volume of this waste.

Sometime also scavengers (Afghani refugees) and waste collectors burn this waste. Moreover, due to this waste, the community has faced many health issues and spread of diseases such as eye irritation and skin allergy, continuous headache, asthma, throat and lungs infection which have not existed before the open waste dumping and burning. Respondents also told the researcher that due to burning of this waste many diseases have been spread-out in their community but nobody noticed this issue. People complained that their family members, especially people of old age and children, have suffered continuous headaches, fever, eyes irritation, skin allergies, sore throat, asthma, breathing difficulties and many other diseases. During a conversation with a 43 year old man, he showed his affected arms (Pictures of his arms are given in Appendix 3) with serious skin allergy. He told the researcher that his wife and 6 year old child also have been suffering from skin allergy due to this waste burning. Another 35 year old woman informed the researcher that due to burning of the waste, her family had suffocation, sore throat and breathing problems for the whole day. Her father and mother-in-law have been suffering from asthma. During this field survey and conversation with local people it was also noted that people were aware that this open burning of waste contributes in air pollution which is a criminal offence. Unfortunately, government does not take any positive action to stop this violation. Mustafa et al. 2009 stated in IUCN (International Union for Conservation of Nature and Natural Resources) that open burning of garbage increases carbon emission which releases toxic compounds into the air and can cause air pollution and global warming.

5.3 Open Waste Dumping and Its Associated Diseases:

During the field visit and visual examination, researcher noticed that TMA vans were openly dumping waste on this site. Picture of TMA van and its open dumping is given in Appendix 3.

Most of the respondents told to the researcher that everyone who is living around this site is completely against of this open waste dumping but unfortunately, this open dumping by TMA has been happening for the past 5 years. Almost each respondent reported that they are mentally and physically disturbed by this action. Out of 20 respondents, 12 mentioned that among their family members someone has suffered from Hepatitis C. The main reason that they mentioned was the drinking of polluted water which is mainly caused by the waste dumping and contaminate the ground water as well as water supply pipes. Another 6 respondents reported that in their family at least one member had been suffering from Dengue fever which is mainly caused by mosquito bites. One respondent told the researcher that last year his cousin died due to Dengue fever. Researcher also came to know that Malaria is a very common disease in this community especially during the monsoon. Respondents told that in rainy season, water gets mixed with this waste and becomes stagnant which improves the breeding of mosquitoes and flies. These mosquitoes are the main reason for the Malaria out-breaks. Moreover, this stagnant water emits an obnoxious smell and due to this smell, everyone suffers from severe headaches and dizziness.

5.4 Respondents Suggestions for Possible Improvements in Waste Disposal System:

During the information collection through question guides and direct communication with the local people, researcher also got some suggestions from them on how to improve the waste disposal system. Some suggestions and possible improvements are mentioned here.

The local people in the village who were interviewed suggested that rather than open waste dumping, land-filling option can be adopted with the help of government and NGOs working on environment and health. Local people together with the government and NGOs can purchase the land, and if government is not willing, the community itself can purchase on installment basis.

The open waste can be removed from the area in the form of land filling system but the TMA should ensure that there is no more open dumping of the whole city’s waste. Another respondent from the village suggested that installation of incineration plant is another robust option to

minimize the volume of the waste and after incineration process, the remaining ash can be disposed of at land filling sites. During a conversation with a TMA staff member he said that for organic waste treatment installation of composting plant is the best and less expensive option for government. By adopting this option, the huge amount of waste can be utilized for making fertilizers. By installation of the incineration or composting plants nearby the community could help to get rid of the waste and its associated diseases. Furthermore, job opportunities would be created for the local people.

A 40 year old man suggested that Malaria and Dengue are epidemic diseases with outbreaks due to mosquitoes attacking, especially in the rainy seasons. To protect from Malaria and Dengue fever, the open waste should be covered by soil or alternatively, the use of appropriate mosquito killing sprays could be beneficial for the surrounding community. During informal discussion many respondents from the village suggested that by making a wall around this waste dumping site, waste will not be spreading all around. Moreover, the movement of cats, dogs, and rodents will be minimized. TMA officials also agreed that by making a wall around this site, dumping of waste will be on an identical place as opposed to random places. Many respondents from the village were against the use of non-biodegradable plastics. Even TMA officials were agreed that these plastics should be strictly banned by the government of Pakistan because due to their non-degradable nature their life span is very high. A 35 year old woman from the village said that these plastics are openly burned by Afghani refugees with other wastes therefore producing many toxic gases and an obnoxious smell into the atmosphere which causes eye and skin allergy especially among children and older people.

Since 2005 Sheikh Sukha waste dumping site is the property of TMA and they have legal rights to dispose of all of the waste which is produced in the city. In this research work it has been noticed that people living around this waste dumping site has protested many times against this

In document Health implications of hospital waste management practices in Gujrat, Pakistan (sider 34-0)